martes, 1 de octubre de 2013

Bloqueo peridural/Epidural nerve block

Recent advances in epidural analgesia.
Bauer M, George JE 3rd, Seif J, Farag E.
Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA.
Anesthesiol Res Pract. 2012;2012:309219. doi: 10.1155/2012/309219. Epub 2011 Nov 24.
Neuraxial anesthesia is a term that denotes all forms of central blocks, involving the spinal, epidural, and caudal spaces. Epidural anesthesia is a versatile technique widely used in anesthetic practice. Its potential to decrease postoperative morbidity and mortality has been demonstrated by numerous studies. To maximize its perioperative benefits while minimizing potential adverse outcomes, the knowledge of factors affecting successful block placement is essential. This paper will provide an overview of the pertinent anatomical, pharmacological, immunological, and technical aspects of epidural anesthesia in both adult and pediatric populations and will discuss the recent advances, the related rare but potentially devastatingcomplications, and the current recommendations for the use of anticoagulants in the setting of neuraxial block placement. 

Predicción de la dificultad en la realización de un bloqueo neuroaxial.      
Predicting the difficulty in performing a neuraxial blockade.
Kim JH, Song SY, Kim BJ.
Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea.
Korean J Anesthesiol. 2011 Nov;61(5):377-81. doi: 10.4097/kjae.2011.61.5.377. Epub 2011 Nov 23.
BACKGROUND: Traumatic placement of a needle during a neuraxial blockade has been related to many complications such as postdural puncture headache, trauma to neural structures and even spinal hematoma, causing permanent neurologic deficits. Although efforts to minimize thecomplications caused by traumatic neuraxial blockade have been made, nothing was found to be clear. The authors investigated the predictors of difficult neuraxial blockade using the first puncture success and number of attempts as measures to assess the difficulty. METHODS: In this prospective observational study, 253 patients scheduled for elective surgery underwent spinal or epidural anesthesia. Patient data (age, sex, height, weight, body mass index, and quality of anatomical landmarks), the provider's level of experience, type of blockade (spinal or epidural), needle type/gauge and the distance from skin to subarachnoid or epidural space were recorded. Significant variables were first determined by Student's t-test and Pearson's chi square test and then logistic and Poisson regression tested the association of the first puncture success and number of attempts with the significant variables. RESULTS:The provider's level of experience and the distance from skin to subarachnoid or epidural space were significant in logistic and Poisson regression. Body mass index was significant only in Poisson regression and the quality of anatomical landmarks was significant only in logistic regression. CONCLUSIONS: Provider's level of experience and the distance from skin to subarachnoid or epidural space influenced the difficulty in performing a neuraxial blockade.
KEYWORDS:Epidural anesthesia, Epidural space, Intraoperative complications, Spinal anesthesia, Subarachnoid space
Anestesiología y Medicina del Dolor
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